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  • 1.
    Ahrne, M.
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Adan, A.
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Andersson, E.
    Karolinska Inst, Stockholm, Sweden.
    Small, R.
    La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Flacking, R.
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Byrskog, U.
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Antenatal care for Somali born women in Sweden - perspectives from mothers, fathers and midwives2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Supplement: 1, p. 104-104Article in journal (Other academic)
  • 2.
    Ahrne, Malin
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Haugesund, Norway.
    Andersson, Ewa
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Adan, Aisha
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Byrskog, Ulrika
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 107-115Article in journal (Refereed)
    Abstract [en]

    Objective:

    To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.

    Design:

    Eight focus group discussions with 2-8 participants in each were conducted, three with Somaliborn mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks".

    Setting:

    Two towns in mid-Sweden and a suburb of the capital city of Sweden. Participants: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.

    Findings:

    Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.

    Key conclusions:

    ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed. (c) 2019 The Authors. Published by Elsevier Ltd.

  • 3.
    Byrskog, Ulrika
    et al.
    School of Education, Health and Social sciences, Dalarna University, Falun, Sweden.
    Ahrne, Malin
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Small, Rhonda
    Mother and Child Health Research, La Trobe University, Melbourne, Victoria, Australia.
    Andersson, Ewa
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Adan, Aisha
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Ahmed, Fardosa Hassen
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Tesser, Karin
    Antenatal Care Clinic, Domnarvet, Borlänge, Sweden.
    Lidén, Yvonne
    Antenatal Care Clinic, Spånga-Tensta, Sweden.
    Israelsson, Monika
    Antenatal Care Clinic, Spånga-Tensta, Sweden.
    Åhman-Berndtsson, Anna
    Antenatal Care Clinic, Domnarvet, Borlänge, Sweden.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e030314Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes.

    OVERALL AIM: To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study.

    METHODS AND ANALYSIS: An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group.

    ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.

  • 4.
    Hesselman, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Ctr Clin Res, Falun, Sweden.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Råssjö, Eva-Britta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Prevalence and risk factors of abdominal adhesions after caesarean section2017In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, no S1, p. 108-108Article in journal (Other academic)
  • 5.
    Nilsen, Roy M.
    et al.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Vik, Eline S.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Rasmussen, Svein A.
    Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Small, Rhonda
    La Trobe Univ, Sch Nursing & Midwifery, Judith Lumley Ctr, Melbourne, Vic, Australia;Karolinska Inst, Dept Womens & Childrens Hlth, Reprod Hlth, Stockholm, Sweden.
    Moster, Dag
    Haukeland Hosp, Dept Paediat, Bergen, Norway;Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Reprod Hlth, Stockholm, Sweden.
    Aasheim, Vigdis
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Preeclampsia by maternal reasons for immigration: a population-based study2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 423Article in journal (Refereed)
    Abstract [en]

    Background:

    To investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration.

    Methods:

    We included 1,287,270 singleton pregnancies (163,508 to immigrant women) in Norway during 1990-2013. Individual data were obtained through record linkage between the Medical Birth Registry of Norway and Statistics Norway. Analyses were performed for preeclampsia overall and in combination with preterm birth < 37 and < 34 weeks of gestation, referred to as preterm and very preterm preeclampsia. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard errors, adjusted for relevant covariates, including maternal income and education.

    Results:

    Preeclampsia was reported in 3.5% of Norwegian women and 2.5% of immigrants. Compared with Norwegian women, the adjusted OR for preeclampsia was lowest in labour immigrants (adjusted OR 0.55 [95% CI 0.49-0.62]), followed by family immigrants (0.62 [0.59-0.65]), immigrant students (0.75 [0.65-0.86]), refugees (0.81 [0.75-0.88]), and immigrants from other Nordic countries (0.87 [0.80-0.94]). Compared with Norwegian women, labour immigrants also had lower adjusted odds of preterm and very preterm preeclampsia, whereas refugees had increased adjusted odds of preterm and very preterm preeclampsia (< 37 weeks: 1.18 [1.02-1.36], and < 34 weeks: 1.41 [1.15-1.72]).

    Conclusions:

    The occurrence of preeclampsia was lower overall in immigrants than in non-immigrants, but associations varied by maternal reasons for immigration. Maternity caregivers should pay increased attention to pregnant women with refugee backgrounds due to their excess odds of preterm preeclampsia.

  • 6.
    Vik, Eline S.
    et al.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Campus Kronstad,Inndalsveien 28, N-5063 Bergen, Norway;Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway.
    Aasheim, Vigdis
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Campus Kronstad,Inndalsveien 28, N-5063 Bergen, Norway.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Campus Kronstad,Inndalsveien 28, N-5063 Bergen, Norway; Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Moster, Dag
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway;Haukeland Hosp, Dept Pediat, Bergen, Norway.
    Nilsen, Roy M.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Campus Kronstad,Inndalsveien 28, N-5063 Bergen, Norway.
    Stillbirth in relation to maternal country of birth and other migration related factors: a population-based study in Norway2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 5Article in journal (Refereed)
    Abstract [en]

    Background: Migrant women's overall increased risk of adverse pregnancy outcomes is well known. The aim of this study was to investigate possible associations between stillbirth and maternal country of birth and other migration related factors (paternal origin, reason for immigration, length of residence and birthplace of firstborn child) in migrant women in Norway.

    Methods: Nationwide population-based study including births to primiparous and multiparous migrant women (n=198,520) and non-migrant women (n=1,156,444) in Norway between 1990 and 2013. Data from the Medical Birth Registry of Norway and Statistics Norway. Associations were investigated by multiple logistic regression and reported as odds ratios (ORs) with 95% confidence intervals (CIs).

    Results: Primiparous women from Sri-Lanka and Pakistan, and multiparous women from Pakistan, Somalia, the Philippines and Former Yugoslavia had higher odds of stillbirth when compared to non-migrant women (adjusted OR ranged from 1.58 to 1.79 in primiparous and 1.50 to 1.71 in multiparous women). Primiparous migrant women whose babies were registered with Norwegian-born fathers had decreased odds of stillbirth compared to migrant women whose babies were registered with foreign-born fathers (aOR=0.73; CI 0.58-0.93). Primiparous women migrating for work or education had decreased odds of stillbirth compared to Nordic migrants (aOR=0.58; CI 0.39-0.88). Multiparous migrant women who had given birth to their first child before arriving in Norway had higher odds of stillbirth in later births in Norway compared with multiparous migrant women who had their first child after arrival (aOR=1.28; CI 1.06-1.55). Stillbirth was not associated with length of residence in Norway.

    Conclusions: This study identifies sub-groups of migrant women who are at an increased risk of stillbirth, and highlights the need to improve care for them. More attention should be paid to women from certain countries, multiparous women who had their first baby before arrival and primiparous women whose babies have foreign-born fathers.

  • 7. Waldenstrom, Ulla
    et al.
    Aasheim, Vigdis
    Britt, Anne
    Nilsen, Vika
    Rasmussen, Svein
    Pettersson, Hans Jarnbert
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Adverse Pregnancy Outcomes Related to Advanced Maternal Age Compared With Smoking and Being Overweight2014In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 123, no 1, p. 104-112Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the association between advanced maternal age and adverse pregnancy outcomes and to compare the risks related to advanced maternal age with those related to smoking and being overweight or obese. METHODS: A population-based register study including all nulliparous women aged 25 years and older with singleton pregnancies at 22 weeks of gestation or greater who gave birth in Sweden and Norway from 1990 to 2010; 955,804 women were analyzed. In each national sample, adjusted odds ratios (ORs) of very preterm birth, moderately preterm birth, small for gestational age, low Apgar score, fetal death, and neonatal death in women aged 30-34 years (n=319,057), 35-39 years (n=94,789), and 40 years or older (n=15,413) were compared with those of women aged 25-29 years (n=526,545). In the Swedish sample, the number of additional cases of each outcome associated with maternal age 30 years or older, smoking, and overweight or obesity, respectively, was estimated in relation to a low-risk group of nonsmokers of normal weight and aged 25-29 years. RESULTS: The adjusted OR of all outcomes increased by maternal age in a similar way in Sweden and Norway; and the risk of fetal death was increased even in the 30-to 34-year-old age group (Sweden n=826, adjusted OR 1.24, 95% confidence interval [CI] 1.13-1.37; Norway n=472, adjusted OR 1.26, 95% CI 1.12-1.41). Maternal age 30 years or older was associated with the same number of additional cases of fetal deaths (n=251) as overweight or obesity (n=251). CONCLUSION: For the individual woman, the absolute risk for each of the outcomes was small, but for society, it may be significant as a result of the large number of women who give birth after the age of 30 years.

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